2: Detecting Consciousness Beyond the Bedside Exam

Frontlines with Frontera is a NeurologyLive podcast hosted by Jennifer Frontera, MD, professor of neurology at NYU Langone Health. Built for clinicians, the series delivers practical, evidence-driven conversations on high-stakes decision-making in neurocritical care and acute neurology, featuring expert insights from leaders across the field.

In part 1 of this 2-part episode of Frontlines with Frontera, host Jennifer Frontera, MD—professor of neurology at NYU Langone Health and neurocritical care specialist—speaks with Brian Edlow, MD, vice chair of research in neurology at Mass General Brigham and associate professor at Harvard Medical School, about the evolving science of consciousness in brain-injured patients. The discussion highlights how clinicians assess wakefulness and awareness, the emergence of covert consciousness detected through advanced EEG and fMRI, and its presence across acute and chronic settings. Edlow also reviews the prognostic implications of these findings in the ICU, the uncertainty surrounding neurologic recovery, and the influence of clinician communication on goals-of-care decisions, while introducing the potential role of multimodal testing and AI-driven models in improving prognostication. (Part 2 will further explore implementation challenges and future directions.)

Episode Breakdown:

• 0:00–3:20 – Defining consciousness: wakefulness vs awareness
• 3:20–7:50 – Covert consciousness: history and prevalence
• 7:50–12:05 – Prognostic implications and ICU decision-making
• 12:05–17:10 – Multimodal testing and AI-driven prognostication
• 17:10–19:30 – Practical EEG/fMRI implementation strategies
• 19:30–24:20 – Limitations: false negatives and interpretation
• 24:20–28:15 – Translating positive findings to clinical outcomes

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